Skip to main content
Log in

Conventional versus computer-navigated TKA: a prospective randomized study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to assess the midterm results of total knee arthroplasty (TKA) implanted with a specific computer navigation system in a group of patients (NAV) and to assess the same prosthesis implanted with the conventional technique in another group (CON); we hypothesized that computer navigation surgery would improve implant alignment, functional scores and survival of the implant compared to the conventional technique.

Methods

From 2008 to 2009, 225 patients were enrolled in the study and randomly assigned in CON and NAV groups; 240 consecutive mobile-bearing ultra-congruent score (Amplitude, Valence, France) TKAs were performed by a single surgeon, 117 using the conventional method and 123 using the computer-navigated approach. Clinical outcome assessment was based on the Knee Society Score (KSS), the Hospital for Special Surgery Knee Score and the Western Ontario Mac Master University Index score. Component survival was calculated by Kaplan–Meier analysis.

Results

Median follow-up was 6.4 years (range 6–7 years). Two patients were lost to follow-up. No differences were seen between the two groups in age, sex, BMI and side of implantation. Three patients of CON group referred feelings of instability during walking, but clinical tests were all negative. NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis, lateral distal femoral angle, medial proximal tibial angle and tibial slope in post-operative radiographic assessment. There was one case of early post-operative superficial infection (caused by Staph. Aureus) successfully treated with antibiotics. No mechanical loosening, mobile-bearing dislocation or patellofemoral complication was seen. At 7 years of follow-up, component survival in relation to the risk of aseptic loosening or other complications was 100 %. There were no implant revisions.

Conclusion

This study demonstrates superior accuracy in implant positioning and statistical significant better functional outcomes of computer-navigated TKA. Computer navigation for TKAs should be used routinely in primary implants.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn 277:7–72

    Google Scholar 

  2. Alcelik IA, Blomfield MI, Diana G, Gibbon AJ, Carrington N, Burr S (2016) A comparison of short-term outcomes of minimally invasive computer-assisted vs minimally invasive conventional instrumentation for primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplast 31(2):410–418

    Article  Google Scholar 

  3. Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplast 20(7 Suppl 3):132–138

    Article  Google Scholar 

  4. Bae DK, Yoon KH, Kim SG et al (2006) Efficacy of computer assisted surgery in revision total knee arthroplasty. J Korean Orthop Assoc 41(6):974–980

    Google Scholar 

  5. Barrett W, Hoeffel D, Dalury D, Mason JB, Murphy J, Himden S (2014) In-vivo alignment comparing patient specific instrumentation with both conventional and computer assisted surgery (CAS) instrumentation in total knee arthroplasty. J Arthroplast 29(2):343–347

    Article  Google Scholar 

  6. Bathis H, Perlick L, Tingart M, Luring C et al (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86(5):682–687

    Article  CAS  PubMed  Google Scholar 

  7. Bathis H, Shafizadeh S, Paffrath T, Simanski C et al (2006) Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies. Orthopade 35(10):1056–1065

    Article  CAS  PubMed  Google Scholar 

  8. Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59(2):241–242

    CAS  PubMed  Google Scholar 

  9. Blakeney WG, Khan RJ, Palmer JL (2014) Functional outcomes following total knee arthroplasty: a trial comparing computer-assisted surgery with conventional techniques. Knee 21(2):364–368

    Article  PubMed  Google Scholar 

  10. Bottros J, Gad B, Krebs V, Barsoum WK (2006) Gap balancing in total knee arthroplasty. J Arthroplast 21:11–15

    Article  Google Scholar 

  11. Châtain F, Gaillard TH, Denjean S, Tayot O (2013) Outcomes of 447 SCORE® highly congruent mobile-bearing total knee arthroplasties after 5–10 years follow-up. Orthop Traumatol Surg Res 99(6):681–686

    Article  PubMed  Google Scholar 

  12. Chauhan SK, Clark GW, Lloyd S et al (2004) Computer-assisted total knee replacement: a controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg 86B(6):818

    Article  Google Scholar 

  13. Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 20(7):1307–1322

    Article  PubMed  Google Scholar 

  14. Choong PF, Dowsey MM, Stoney JD (2009) Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplast 24:560–569

    Article  Google Scholar 

  15. Cip J, Widemschek M, Luegmair M, Sheinkop MB, Benesch T, Martin A (2014) Conventional versus computer-assisted technique for total knee arthroplasty: a minimum of 5-year follow-up of 200 patients in a prospective randomized comparative trial. J Arthroplast 29(9):1795–1802

    Article  Google Scholar 

  16. Daines BK, Dennis DA (2014) Gap balancing vs. measured resection technique in total knee arthroplasty. Clin Orthop Surg 6(1):1–8

    Article  PubMed  PubMed Central  Google Scholar 

  17. de Steiger RN, Liu YL, Graves SE (2015) Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age. J Bone Joint Surg Am 97(8):635–642

    Article  PubMed  Google Scholar 

  18. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:249

    Google Scholar 

  19. Fehring TK (2000) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res 380:72–79

    Article  Google Scholar 

  20. Haaker RG, Stockheim M, Kamp M, Proff G et al (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  Google Scholar 

  21. Hernandez-Vaquero D, Suarez-Vazquez A, Iglesias-Fernandez S (2011) Can computer assistance improve the clinical and functional scores in total knee arthroplasty? Clin Orthop Relat Res 469:3436

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplast 27(6):1177–1182

    Article  Google Scholar 

  23. Huang TW, Peng KT, Huang KC et al (2014) Differences in component and limb alignment between computer-assisted and conventional surgery total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:2954–2961

    Article  PubMed  Google Scholar 

  24. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  25. Insall JN, Ranawat CS, Aglietti P et al (1976) A comparison of four models of total knee replacement prostheses. J Bone Joint Surg Am 58:754

    Article  CAS  PubMed  Google Scholar 

  26. Jenny JY, Clemens U, Kohler S, Kiefer H et al (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplast 20(7):832–839

    Article  Google Scholar 

  27. Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE (2009) Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop 33(6):1567–1570

    Article  PubMed  Google Scholar 

  28. Kim YH, Kim JS, Choi Y et al (2009) Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 91:14

    Article  PubMed  Google Scholar 

  29. Lee CY, Lin SJ, Kuo LT, Peng KT, Huang KC, Huang TW, Lee MS, Hsu R, Shen WJ (2014) The benefits of computer-assisted total knee arthroplasty on coronal alignment with marked femoral bowing in Asian patients. J Orthop Surg Res 9(1):122

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19(12):2027–2032

    Article  PubMed  Google Scholar 

  31. Lehnen K, Giesinger K, Warschkow R, Porter M, Koch E, Kuster MS (2010) Clinical outcome using a ligament referencing technique in CAS versus conventional technique. Knee Surg Sports Traumatol Arthrosc 19(6):887–892

    Article  PubMed  PubMed Central  Google Scholar 

  32. MacDessi SJ, Jang B, Harris IA, Wheatley E, Bryant C, Chen DB (2014) A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee 21(2):406–409

    Article  PubMed  Google Scholar 

  33. Matsumoto T, Muratsu H, Kawakami Y, Takayama K, Ishida K, Matsushita T, Akisue T, Nishida K, Kuroda R, Kurosaka M (2014) Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. Int Orthop 38(3):531–537

    Article  PubMed  Google Scholar 

  34. Pang HN, Yeo SJ, Chong HC et al (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 19:1496–1503

    Article  PubMed  Google Scholar 

  35. Parratte S, Pagnano MW, Trousdale RT et al (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg 92:2143

    Article  PubMed  Google Scholar 

  36. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85(2):259–265

    Article  PubMed  Google Scholar 

  37. Roberts TD, Clatworthy MG, Frampton CM, Young SW (2015) Does computer assisted navigation improve functional outcomes and implant survivability after total knee arthroplasty? J Arthroplast 30(9 Suppl):59–63

    Article  Google Scholar 

  38. Schroer WC, Berend KR, Lombardi AV et al (2013) Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplast 28:116–119

    Article  Google Scholar 

  39. Spencer JM, Chauhan SK, Sloan K et al (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89(4):477–480

    Article  CAS  PubMed  Google Scholar 

  40. Stucki G, Meier D, Stucki S et al (1996) Evaluation of a German version of WOMAC (Western Ontario and MacMaster Universities) Arthrosis index. Z Rheumatol 55:40

    CAS  PubMed  Google Scholar 

  41. Tantavisut S, Tanavalee A, Ngarmukos S, Yuktanandana P, Wilairatana V, Wangroongsub Y (2013) Accuracy of computer-assisted total knee arthroplasty related to extra-articular tibial deformities. Comput Aided Surg 18(5–6):166–171

    Article  PubMed  Google Scholar 

  42. Tigani D, Sabbioni G, Ben Ayad R, Filanti M, Rani N, Del Piccolo N (2010) Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique. Knee Surg Sports Traumatol Arthrosc 18:1304–1310

    Article  PubMed  Google Scholar 

  43. Versier G, Ollat D, Nader Y, Barbier C, Bures C (2008) Apport de la navigation dans les prostheses totals du genou. Résultats de nos 100 premiers cas et revue de la literature. Acad Natl Chir 7:64–68

    Google Scholar 

  44. Warren PJ, Olanlokun TK, Cobb AG, Walker PS, Iverson BF (1994) Laxity and function in knee replacements. A comparative study of three prosthetic designs. Clin Orthop Relat Res 305:200–208

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luca Garro.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Todesca, A., Garro, L., Penna, M. et al. Conventional versus computer-navigated TKA: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 25, 1778–1783 (2017). https://doi.org/10.1007/s00167-016-4196-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4196-9

Keywords

Navigation